Occupational Exposure to Bloodborne Pathogens

Since a bloodborne pathogen exposure places an individual at risk for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) infection, and/or syphilis infection, students must seek medical attention as soon as possible after an exposure occurs. Any medical student who sustains an exposure to blood or body fluids should be managed according to currently recommended guidelines from the Centers for Disease Control and Prevention (CDC) and according to the policies and procedures of the institution in accordance with LCME element 12.8.

"A medical school has policies in place that effectively address medical student exposure to infectious and environmental hazards, including:

• The education of medical students about methods of prevention.
• The procedures for care and treatment after exposure, including a definition of financial responsibility.
• The effects of infectious and environmental disease or disability on medical student learning activities.

All registered medical students (including visiting students) are informed of these policies before undertaking any educational activities that would place them at risk.”

Proper steps must be taken to ensure that both evaluations and preventive measures are instituted in a timely manner. The steps noted below should be followed when exposure occurs in a medical student.

1. Cleanse thoroughly the exposure site immediately following the exposure. Irrigate eye with water keeping the affected eye lower than the unaffected eye during irrigation.
2. Note the patient's name, the location where the exposure occurred, the date and time of the exposure, the rotation, the names of witnesses, and, in the case of a needle stick, the type (hollow bore or solid).
3. Notify the employee health office or the safety officer during regular working hours.
4. If appropriate, after assessments are performed and based on current guidelines, the student may be offered antiviral prophylaxis against HIV. After discussion of the risks and benefits of antiviral prophylaxis, a student should be dispensed a 96-hour supply of the antiviral medications. All exposed individuals must be counseled on the importance of follow-up evaluations. Each exposed individual must have a follow-up evaluation within 96 hours of the exposure. Follow-up of the student must be ensured. The following should be done:
   1. a. Notify the employee health service of the institution and the Associate Dean for Student Affairs and Admissions as soon as possible but not later than 96 hours (4 days) following the initial evaluation. (See list of contact addresses and telephone/FAX numbers at the end of this policy.)
   2. b. Ensure that copies of all records are confidentially forwarded as soon as possible but not later than 96 hours following the initial evaluation to the employee health service of the institution. Medical student records should be forwarded to the Office of Student Affairs and Admissions. The Office of Student Affairs and Admissions will report the incident to the WSU Department of Environmental Health and Safety and the State of Ohio.
   3. c. The medical student must be instructed on the requirement for follow-up evaluations within the 96-hour period. Appropriate educational and medical support must be provided through the School or the Office of Student Affairs.
5. Financial charges not covered by the student’s insurance during the evaluation should be forwarded to the Office of Student Affairs and Admissions.

Minimizing Risks

All students must follow policies and procedures according to the most current published CDC guidelines regarding use of precautionary measures to minimize the risk of HBV, HCV, and HIV transmission as well as any and all communicable diseases. Students must practice these precautions:

• Routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids of any patient is anticipated. Examples of protective barriers include gloves, gowns, masks, and protective eyewear.
• Wear gloves when touching blood and body fluids, mucous membranes or non-intact skin of all patients; when handling items or surfaces soiled with blood or body fluids; and when performing venipuncture and other vascular access procedures. Gloves should be changed after contact with each patient.
• Wear masks and protective eyewear or face shields during procedures that are likely to generate droplets or splashes of blood or other body fluids to prevent exposure of mucous membranes of the mouth, nose, and eyes. Fluid-resistant gowns or aprons should be worn during procedures that are likely to generate splashes of blood or other body fluids.
• Wash hands before and after contact with patients and immediately after protective gloves are removed. Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids. • Take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices during procedures.
• Take precautions when cleaning used instruments, when disposing used needles, and when handling sharp instruments after procedures.
  • To prevent needlestick injuries, needles should NEVER be recapped, purposely bent or broken by hand, removed from disposable syringes or otherwise manipulated by hand.
  • Used, disposable syringes and needles, scalpel blades and other sharp items should be placed in puncture resistant containers for disposal.
  • Large-bore, reusable needles should be placed in puncture-resistant containers for transport to the reprocessing area.
• Use mouthpieces, resuscitation bags, or other ventilation devices whenever possible for emergency mouth-to-mouth resuscitation.
• Refrain from all direct patient care and from handling patient-care equipment if you have exudative lesions or weeping dermatitis until the condition resolves or the areas are adequately protected.

NOTE: Students who are pregnant should be especially familiar with and strictly adhere to precautions to minimize the risk of transmitting bloodborne pathogens to themselves and their fetus. If you are not provided with appropriate preventative equipment, please contact Office of Student Affairs as soon as possible.

Managing Chronic HBV, HCV, and HIV for Infected Students

Students who believe or have reason to believe that they are infected with HIV, HCV or HBV must report that fact to the Associate Dean for Student Affairs and Admissions prior to performing an invasive procedure where there is a risk of contact between the blood or body fluids of the student and the blood or body fluids of the patient. The Associate Dean will require confirmation from a qualified physician as to the student's diagnosis, state of health, and symptoms.

Having identified a student with HBV, HCV and/or HIV, the Associate Dean will coordinate an ad hoc committee including, if possible, the student's physician, an infectious disease specialist or credentialed HIV specialist, and the Associate Dean of Academic Affairs or appointee who is familiar with the clinical curriculum. The ad hoc committee will evaluate the student's course work and patient contact to determine appropriate clinical curricular changes based on guidelines from the Ohio Department of Health (ODH) and the Center for Disease Control (CDC). The committee shall report any recommendations to the Associate Dean for Student Affairs and Admissions who in turn will notify the student and clerkship directors, as needed, of any requirements and/or limitations placed on the student's clinical activity. A student who fails to comply with the requirements and/or limitations will be subject to discipline up to or including a recommendation for dismissal.

All information regarding the HBV, HCV and/or HIV status of a student shall be held in strict confidence.

Protocol to Follow If Blood or Body Fluid Exposure Occurs

1. Follow institutional protocol for post-exposure care (washing, irrigating, etc.)
2. Notify the safety officer to get the patient tested (unless already known to be positive): Hepatitis B & C & a RAPID HIV. If the patient tests negative, the student will not need to be tested.
3. Email: Dr. Miriam Lader at miri.lader@wright.edu.
4. Help? Contact the clerkship director or coordinator

Regarding needle stick or other exposure incidents that may happen while you are on an away rotation at another institution during your 4th year:

1. BSOM students on external rotations at other “host” institutions must follow the host institution’s policy for responding to needle stick or other exposure incidents.
2. Coverage for costs incurred for evaluation and any treatment will first go to the student’s health insurance policy. Financial costs not paid will be covered by BSOM’s Office of Student Affairs.
3. If a needle stick or other exposure does occur, BSOM students must also inform BSOM Office of Student Affairs at 937.775.2934.